Creating a comprehensive, customized care plan for complex patients involves an immense amount of effort. In addition, physicians also face the challenge of figuring out the proper billing care of these patients. To ensure physicians are being paid correctly for the treatments they provide, we have put together a summary of the Comprehensive Care Management (CCM) tariffs and Chronic Disease Management (CDM) tariffs and offer some tips on when and how to bill them.
What are the CDM and CCM Tariffs?
CDM and CCM are two sets of tariffs created by Manitoba Health to support physicians in the provision of care to complex patients to promote continuity, comprehensiveness, coordination, access, and patient centered care.
In Manitoba, the chronic diseases that are billable for both CDM and CCM tariffs include:
- Asthma (plus OPCD for CCM)
- Congestive Heart Failure
- Coronary Artery Disease
CDM tariffs can be billed by physicians who have provided the majority of a patient’s ongoing comprehensive care in relation to the active management of specific chronic disease(s) during the preceding 12 months. The tariffs for CDM were made effective on April 1, 2012. There are five specific tariff codes for chronic care patients that can be billed:
|8431||Annual Management of Diabetes||$45|
|8432||Annual Management of Asthma||$20|
|8433||Annual Management of Congestive Heart Failure||$45|
|8434||Annual Management of Coronary Artery Disease||$45|
|8435||Annual Management of Hypertension||$45|
Some requirements for billing in this model:
- Be a general practice physician.
- Provide the majority of a patient’s ongoing comprehensive medical care in relation to the management of the chronic disease in the preceding 12 months.
- Provide ongoing coordination with other allied health care providers respecting the management of the patient’s condition and patient care plan, as appropriate.
- Provide ongoing communication with the patient, monitoring of the patient’s condition and patient care plan, as appropriate.
- Ensure all required services for a particular tariff (e.g., Diabetes, Asthma, Congestive Heart Failure, etc.) have been provided to the patient within the preceding 12 months.
- Each tariff may only be claimed once per patient in any 12-month period. Only one physician may claim each tariff for a single patient in a 12-month period.
- Where a patient is treated for the management of more than one of the listed diseases, a tariff may be billed for each disease. For example, two separate claims must be submitted when billing CDM tariffs for both Diabetes (8431) and Coronary Artery Disease (8434) for a single patient.
- Claims for additional services (e.g., visits) are payable in addition to these tariffs.
We have created a quick reference guide with some tips for understanding the CDM model. You can download it here.
CCM tariffs have been in effect since April 1, 2017 and are available to physicians for the annual management of primary care for enrolled patients. The following are the five CCM tariffs:
|Tariff||Number of chronic diseases||Rate|
|8454||0 chronic disease, age 50-74||$15|
|8455||0 chronic diseases, age 75+||$20|
|8456||1 chronic disease||$60|
|8457||2 chronic diseases||$105|
|8458||3 or more chronic diseases||$150|
Some requirements for billing in this model:
- Tariffs may only be claimed for enrolled patients. There are two methods to enroll patients:
- Communicating with the patient to establish an enrolment agreement.
- Through analysis of the EMR chart data to infer a continuous comprehensive relationship with the patient.
- Tariffs are payable only to the physicians who have provided the patient ongoing comprehensive primary care during the preceding 12 months.
- Tariffs 8454, 8455, 8456, 8457 and 8458 may only be claimed once per patient during any 12-month period and cannot be claimed in combination with any other CCM tariff or CDM tariff. Claims for additional services rendered to an enrolled patient (e.g., visits) may be made in addition.
- Physicians must use an EMR and services must be documented in such EMR.
For quick tips and definitions, download our CCM Quick Reference Guide.
When to Bill CDM vs. CCM?
Physicians can claim CDM tariffs on some patients in their practice and CCM tariffs on other patients. Manitoba Health’s Claims Processing System (CPS) will only allow a physician to claim CDM or CCM tariffs for a patient every 12 months. They cannot be claimed together at the same time for the same patient. Because physicians have the option to choose to claim CDM or CCM tariffs for each individual patient, it is important to know the differences to ensure you are maximizing your billing opportunities for the care provided to patients.
The patient care and the level of work required is the same between the CDM and CCM models but there are a couple of differences that may help you decide which one to bill:
In the chart below, the CDM and CCM models are compared for each situation. As shown, the amount a physician can claim for the CDM and CCM tariffs change depending on the patient’s conditions.
|Situation||Condition||CDM||CCM||CDM or CCM?|
|1||No chronic disease, age 50-74||$0||$15||CCM|
|2||No chronic disease, age 75+||$0||$20||CCM|
|3||1 chronic disease (asthma)||$20||$60||CCM|
|4||1 chronic disease||$45||$60||CCM|
|5||2 chronic diseases (asthma included)||$65||$105||CCM|
|6||2 chronic diseases||$90||$105||CCM|
|7||3 chronic diseases (asthma included)||$110||$150||CCM|
|8||3 chronic diseases||$135||$150||CCM|
|9||4 chronic diseases (asthma included)||$155||$150||CDM|
|10||4 chronic diseases||$180||$150||CDM|
|11||5 chronic diseases||$200||$150||CDM|
For patients with up to three chronic diseases (situations 1-8), and given the appropriate level of care is provided, it is optimal to enroll your patients in the CCM model. For patients with four chronic diseases or more (situation 9-11), it is optimal to claim each chronic disease separately using the CDM tariffs.
Method to Submit Tariffs
The decision about when to bill CDM or CDM for your comprehensive care patients may also depend on your preferred method for submitting tariffs. If you prefer to submit physical copies of your tariffs, claiming the CDM tariffs allows for a variety of submission options including mail, drop off, online submission, or directly into your EMR. Billing CCM tariffs requires the use of an EMR.
How to Submit your CDM or CCM Tariffs
Chronic Disease Management Tariffs
CDM tariffs require Patient Care Treatment Forms be completed and sent through one of the following methods:
- Mail: Paper copies of the completed Patient Care Treatment Forms can be mailed to the Claims Unit at 300 Carlton Street.
- Drop off: Paper copies of the completed Patient Care Treatment Forms may be dropped off at 300 Carlton Street.
- Completion of the eForm: The eForms can be completed on-line and electronically submitted directly to a secure government repository.
- EMR data extract: Physicians using a Manitoba-approved EMR system can submit the supporting information through a monthly data extract from their EMR. Please contact the Primary Health Care Branch at 204-788-6732, or by email at email@example.com for more information.
Access Patient Care Treatment Forms
Fill and Print Forms:
Comprehensive Care Management Tariffs
CCM tariff claims must be documented in the EMR and communicated to Manitoba Health through data extracts compatible with Manitoba Health’s information system.
There are two methods of submission:
- EMR extract: Physicians can submit through a secure electronic interface on a monthly basis; or
- Encrypted electronic device: Physicians can submit using an encrypted electronic device (e.g., CD or flash drive) on a quarterly basis (commencing on April 1 of each year), within 15 calendar days of the end of each quarter.
Note: While you do not need to use a certified or approved EMR system to submit CCM tariffs, your EMR must be able to produce the Primary Care Data Extract. If you have any questions, please contact your vendor.
DoctorCare helps doctors sort through confusing billing rules, automate billing submissions, ensure errors are fixed, and optimize billings to maximize revenue. If you are interested in learning more about how we can help, contact us to set up a free consultation.